Dysthymia

Persistent depressive disorder, also called dysthymia, is a form of chronic depression. It includes symptoms similar to major depression, but they are more severe and longer lasting. Persistent depressive disorder represents a new diagnosis, combining both dysthymia and chronic major depressive disorder. If a child presents with depressed or irritable mood on most days for more than a year, he or she may have persistent depressive disorder.

The condition:

• Is less severe than major depression, but lasts for longer periods of time
• Is marked by persistent feeling of mild depression or irritability but may cause more extreme feelings from time to time 
• Is often undiagnosed, and if left untreated can lead to more serious mental health and behavioral problems
• Can be treated using psychotherapy and medication

Persistent depressive disorder is a condition that can affect anyone regardless of age, race, ethnic background, gender, or income level.

Depression is one of the most common mental health disorders in the United States. About 11 percent of 13- to 18-year-olds experience either persistent depressive disorder or major depressive disorder.

Being a little sad or moody can be normal in children and adolescents. Depression involves a child’s body, mind, and thoughts. A child with depression will often demonstrate appetite or sleep changes or other changes in their behavior. Academic performance and social functioning may be affected. If these symptoms persist the child may have persistent depressive disorder. It is important for your child to be evaluated by a mental health professional if you notice significant changes in his or her mood and behavior.

• You should seek prompt treatment for your child if any of the following symptoms persist for two weeks or more:
  • Feeling sad, worried, or hopeless
  • Expressing low self-esteem or making negative comparisons to peers (“I’m so stupid compared to everyone else in the class,” “I’m so much uglier than all my friends”)
  • Sleeping too often or not often enough
  • Withdrawal from family and friends (constantly staying in her room with the door closed, not taking calls or visitors)
  • Sudden change in weight or appetite
  • Unprovoked irritability, hostility, or aggression
  • Diminished performance in school
  • Complaining of headaches, stomachaches, or other physical symptoms with no identifiable medical cause
• If your child:
  • Begins giving away treasured possessions
  • Refers to “not being around” in the future
  • Expresses a wish to “disappear” or “sleep forever”
  • Expresses a desire to die
  • Mentions a plan to die ... you should always take these warning signs of suicide very seriously and seek immediate help.

Both children and adults can be diagnosed with persistent depressive disorder. In adults, persistent depressive disorder presents with chronic depressed mood, whereas in children the mood may be irritable or depressed. Children and adolescents must present with symptoms for one year, but in adults the symptoms must be present for at least two years.

The exact cause for persistent depressive disorder is not known, but experts point to several risk factors for developing depressive disorders:

• Family history of depressive disorder
• Temperamental factors: negative affectivity
• Environmental stressors such as:
  • Death of a parent, relative, or friend
  • Abuse or neglect
  • Other mental health problems such as anxiety
  • Divorce or illness in the family
  • Dealing with a chronic medical illness
  • Chronic social or academic difficulties

A child or adolescent with persistent depressive disorder will experience a depressed or irritable mood on most days for at least a year. In addition, the child will exhibit appetite changes, sleep disturbances, fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of hopelessness.

A child psychiatrist or other mental health professional typically diagnoses persistent depressive disorder after conducting a thorough psychiatric evaluation. Such an evaluation will involve an interview with the child and with the family. Many times the child’s school will be consulted to provide additional information.

If your child’s healthcare provider diagnoses your child with persistent depressive disorder, treatment options will be presented to you, including the potential risks and benefits of possible treatments. Taking into consideration your opinions and preferences, your healthcare provider will work with you and your child to create the most appropriate treatment plan.

Treatment for persistent depressive disorder consists of psychotherapy and medication. Evidence-based psychotherapeutic interventions for depression include cognitive behavioral therapy and interpersonal therapy. Combination treatment using psychotherapy and antidepressant medication has shown to be the most effective intervention. The antidepressant medications most commonly used are the selective serotonin reuptake inhibitors (SSRIs). Children and adolescents need to be monitored very closely by their healthcare team when antidepressant medications are being initiated or doses are being increased. The Outpatient Psychiatry Service at Boston Children’s Hospital is experienced in the assessment and treatment of depressive disorders in children and adolescents. For more information please call 617-355-6680.

There is some evidence that treating depression in parents can help prevent the development of depression in their children. Intervention strategies targeting families of children at risk for depression have demonstrated some efficacy for preventing depressive symptoms in these children.

Those with persistent depressive disorder are at high risk of going on to develop a major depressive episode. People that develop persistent depressive disorder earlier in life (<21 years of age) tend to have a poorer prognosis than those that develop the disorder later in life. Children with persistent depressive disorder who do not receive treatment are more likely to develop personality disorders and substance use disorders in adulthood. Early identification and treatment of the disorder is important to minimize the long-term impact on the child or adolescent.